Acute non traumatic cervical mielopathy in an adult patient: a challenging diagnosis. Case report.

Abstract

Introduction Acute cervical myelopathy is a challenging diagnosis. Spinal cord infarction is generally caused by aortic pathologies. In absence of a definite diagnosis, fibrocartilagineous embolism can be a cause of spinal cord ischemia. Case presentation Authors here presented a case report of a 42 years old female patient, suffering acute myelopathy in a stenotic cervical canal by anterior osteophytes. She was admitted to our emergency department with chest pain and tetraparesis, manifesting with two acute episodes within 24 hours of each other, the second worse than the first. Traumatic, inflammatory, ischemic, infectious and compressive causes were excluded. Both neuroprotection therapies (administration of glucocorticoids, maintenance of mean arterial pressure) and surgical decompression of stenotic cervical canal were adopted. Follow-up was characterized by neurological improvement. Conclusions To our knowledge, the case here reported is the first of a suspected FCE in a stenotic CC surgically decompressed. FCE is generally an exclusive diagnosis; definite diagnosis could be only provided by spinal cord biopsy examination. Cervical canal decompression, by removing anterior osteophytes, probably contributed to SC adequate vascular perfusion through the anterior spinal artery and prevented secondary damage from medullary swelling.